Provider Demographics
NPI:1154043867
Name:SMILE REHAB CENTERS
Entity type:Organization
Organization Name:SMILE REHAB CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANIFE
Authorized Official - Middle Name:CANAN
Authorized Official - Last Name:BAYRAKTAROGLU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:737-747-2221
Mailing Address - Street 1:245 W STATE HIGHWAY 114 STE 130
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3637
Mailing Address - Country:US
Mailing Address - Phone:737-747-2221
Mailing Address - Fax:
Practice Address - Street 1:245 W STATE HIGHWAY 114 STE 130
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3637
Practice Address - Country:US
Practice Address - Phone:737-747-2221
Practice Address - Fax:737-273-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty